Roof Condition Certification

Citizens Property Insurance Corporation — Form RCF-1
RCF-2026-SAMPLE
Citizens RCF-1 01/18
Applicant / Insured Information
Applicant/Insured Name: John & Maria Rodriguez
Application/Policy #: HO-FL-2025-4829371
Date of Inspection: 03/12/2026
Property Address: 1234 Palm Harbor Drive, Tampa, FL
Predominant Roof Covering
Roof Material: Asphalt/Fiberglass Shingle
Approximate Age: 8 years
Remaining Useful Life: 17 years
Last Permit Date: 2018-03-15
Update Type: Full Replacement
Condition:
Roof Condition — Damage / Deterioration Noted
Cracking
Cupping / Curling
Granule Loss
Exposed Asphalt / Felt
Missing Tabs / Shingles
Soft Spots / Decking Issues
Hail Damage
Missing / Broken Tiles
Slipping Tiles
Lifted / Buckled Shingles
Sagging / Structural Deflection
Visible Signs of Leaks
Debris Accumulation
Biological Growth (Moss/Algae)
Damaged / Missing Flashing
Improper / Temporary Repairs
Overall Roof Condition Assessment
Overall Condition: Satisfactory

Roof Condition Certification — Inspector Certification

Citizens RCF-1 — Page 2
RCF-2026-SAMPLE
Inspector Certification

I certify that I have personally inspected the roof of the above-referenced property and that the information provided in this form is true and correct to the best of my knowledge and belief. I am a qualified inspector as defined by Citizens Property Insurance Corporation.

Inspector Name: Calvin S. Johnson
Title:
License Number: HI-14823
License Type: Florida Licensed Home Inspector
Company:
Work Phone:
Date Signed:
Signature:
Not yet signed
Special Instructions & Photo Requirements

Photo Requirements: A minimum of two (2) photographs of the roof are required. Photos must show each roof slope (side) of the property. Additional photos should be included for any areas of damage, deterioration, or deficiency noted above.

Documenting Condition: If the roof condition is documented as "Unsatisfactory," the inspector must provide detailed notes explaining the nature and extent of the deficiency in the Additional Observations section.

Note to All Agents: This form must be completed by a qualified inspector and submitted with the application for new business or upon request for renewal. Incomplete forms will be returned for correction.

Additional Comments / Observations